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General NPI Number Information
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NPI Number | 1205101334
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Entity Type | Individual
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Provider Name | THOMAS JOHN GNIADEK MD PHD
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Gender | Male
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Dates
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Enumeration Date | 03/22/2012
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Last Update Date | 01/07/2026
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Provider Practice Location Address
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Address Line | 1402 S GRAND BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63104-1004
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Country | US
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Telephone | 314-617-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 844 KNOLLWOOD RD
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City | DEERFIELD
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State | IL
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Zip | 60015-3313
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Country | US
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Telephone | 203-806-0125
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZB0001X
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Taxonomy Name | Blood Banking & Transfusion Medicine Physician
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License Number | 036145372
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 036145372
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 2024018547
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 207ZB0001X
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Taxonomy Name | Blood Banking & Transfusion Medicine Physician
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License Number | 2024018547
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License Number State | MO
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